salicylates and Hemorrhage

Different studies have shown that aspirin (AAS), in low doses, may lead to a considerable frequency of hemorrhagic complications when used in the long term.. We compare the long-term occurrence of hemorrhagic complications with low doses of AAS and high doses of triflusal.. Our series included 106 patients who took 900 mg triflusal per day (300 mg 3 times per day) and 111 who took AAS (330 mg/day once daily). The former were followed up for an average period of 48.3 months (20-94) and the latter for 46.3 months (2-84). The average follow-up period for the study was 47.3 months. The presence of hemorrhagic complications was evaluated, as was their frequency and follow-up curve.. Compared with AAS, triflusal led to a 76% reduction in risk of hemorrhagic complications (2.8% against 10.8%; OR 0.24; IC 0.06-0.94). There was a slightly increased incidence of hemorrhages in the women's group. There were more hemorrhages than gastrointestinal hemorrhages (4.5% against 0.9%) and intracranial hemorrhages (1.8%-0.9%). The follow-up curve showed significant differences in the form of an increased risk of hemorrhagic complications with AAS.. The risk of hemorrhage with AAS depended on the period of follow-up, in a similar manner to with oral anticoagulant agents, in patients with prophylaxis of cerebral infarct. On the other hand, this did not occur with triflusal, with which the risk was homogeneous and lower in the long term.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Cerebral Infarction; Female; Follow-Up Studies; Hemorrhage; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Risk Factors; Salicylates; Sex Factors; Time Factors

Topics: Acetaminophen; Acid-Base Equilibrium; Acidosis; Acute Kidney Injury; Alkalosis, Respiratory; Aspirin; Calcium; Coma; Dehydration; Fever; Gastric Lavage; Hemorrhage; Humans; Hydrogen-Ion Concentration; Infusions, Parenteral; Poisoning; Salicylamides; Salicylates; Seizures; Tetany; Vomiting

Topics: Administration, Oral; Aspirin; Biopharmaceutics; Dosage Forms; Drug Compounding; Evaluation Studies as Topic; Gastrointestinal Motility; Half-Life; Hemorrhage; Humans; Intestinal Absorption; Kinetics; Salicylates; Time Factors

Topics: Anti-Bacterial Agents; Congenital Abnormalities; Conjunctiva; Diagnosis; Eye Diseases; Eye Neoplasms; Eyelids; Hemorrhage; Humans; Hydantoins; Infections; Irritants; Keratoconjunctivitis; Lacrimal Apparatus; Lacrimal Duct Obstruction; Mycoses; Pathology; Salicylates; Sulfonamides; Surgical Procedures, Operative; Therapeutics; Toxicology; Trachoma

Triflusal has demonstrated an efficacy similar to aspirin in the prevention of vascular events in patients with acute myocardial infarction (ΜΙ) and ischaemic stroke but with less bleeding events.. We performed a randomised, multicentre, phase 4 clinical trial to compare the clinical efficacy and safety of triflusal versus aspirin, administered for 12 months in patients eligible to receive a cyclooxygenase-1 (COX-1) inhibitor.. Patients with stable coronary artery disease or with a history of non-cardioembolic ischaemic stroke were randomly assigned to receive either triflusal 300 mg twice or 600 mg once daily or aspirin 100 mg once daily for 12 months. The primary efficacy endpoint was the composite of: (a) ΜΙ, (b) stroke (ischaemic or haemorrhagic), or, (c) death from vascular causes for the entire follow-up period. The primary safety endpoints were the rate of bleeding events as defined by Bleeding Academic Research Consortium (BARC) criteria.. At 12-month follow-up, an equivalent result was revealed between the triflusal (n=559) and aspirin (n=560) in primary efficacy endpoint. Specifically, the combined efficacy outcome rate (i.e. MI, stroke or death from vascular causes) difference was equal to -1.3% (95% confidence interval -1.1 to 3.5) and lied within the a-priori defined equivalence interval (p<0.001). Regarding the primary safety endpoints, patients on triflusal treatment were 50% less likely to develop bleeding events according to the BARC criteria, and especially any clinically overt sign of haemorrhage that requires diagnostic studies, hospitalisation or special treatment (BARC type 2).. The efficacy of triflusal in the secondary prevention of vascular events is similar to aspirin when administered for 12 months. Importantly, triflusal significantly reduced the incidence of ΜΙ and showed a better safety profile compared with aspirin. (ASpirin versus Triflusal for Event Reduction In Atherothrombosis Secondary prevention, ASTERIAS trial; Clinical Trials.gov Identifier: NCT02616497).

Topics: Aged; Aspirin; Brain Ischemia; Coronary Artery Disease; Cyclooxygenase Inhibitors; Female; Greece; Hemorrhage; Humans; Intracranial Embolism; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Recurrence; Risk Factors; Salicylates; Secondary Prevention; Stroke; Time Factors; Treatment Outcome

The mean follow-up in the clinical trials of antiplatelet drugs in the secondary prevention of ischemic atherothrombotic stroke ranges from 1 to 5.5 years. Thus, the safety and efficacy of these drugs in the very long term is not totally documented. We have assessed the safety and effectiveness of triflusal and aspirin for a very long-term period in the secondary prevention of patients with ischemic atherothrombotic stroke.. Patients with atherothrombotic ischemic stroke, including TIA, who participated in randomized clinical trials of triflusal versus aspirin were included in the study. The period of recruitment was between 1983 and 1999. After finishing their participation in the clinical trials, patients were followed up in the Neurology Department of our hospital. All patients were treated with aspirin or triflusal during a mean period of 17.2 years. Groups were comparable with respect to sex, age, risk factor and etiology of the stroke. Adverse events and vascular events (including stroke recurrence, ischemic heart disease and vascular death) that appeared throughout the study were registered. Statistical analysis was performed using the statistical package SPSS 15.0 for Windows. Kaplan-Meier curves and the log-rank test were used to compare treatments.. A total of 441 patients (305 men) with a mean age (±SD) of 51.1±12.4 years were included in the study; 288 patients (65.3%) were treated with triflusal and 153 with aspirin. There were no statistically significant differences between aspirin and triflusal concerning new vascular events (72.5 vs. 60.4%; p=0.28), stroke recurrence (49.7 vs. 46.5%; p=0.53), ischemic heart events (54.9 vs. 55.6%; p=0.90), vascular death (25.5 vs. 24%; p=0.73) and global mortality (42.5 vs. 42%; p=0.92). The incidence of serious bleeding (upper digestive tract hemorrhage and cerebral hemorrhage) was 18.3% in aspirin-treated patients and 5.5% in triflusal-treated patients (p<0.001). In reference to other adverse events, no significant differences were found between aspirin and triflusal.. In the secondary prevention of ischemic stroke, very long-term treatment with triflusal or aspirin seems to have a similar efficacy, but triflusal is safer with a lower hemorrhagic risk. Triflusal may be an alternative therapy, particularly in patients who present aspirin resistance.

Topics: Aged; Aspirin; Brain Ischemia; Dyspepsia; Female; Follow-Up Studies; Hemorrhage; Humans; Incidence; Intracranial Arteriosclerosis; Ischemic Attack, Transient; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Ischemia; Platelet Aggregation Inhibitors; Recurrence; Salicylates; Secondary Prevention; Vascular Diseases

This trial evaluated the efficacy and safety of the combination of antiplatelet and moderate-intensity anticoagulation therapy in patients with atrial fibrillation associated with recognized risk factors or mitral stenosis.. Warfarin was more effective than aspirin in preventing stroke in these patients; combined therapy with low anticoagulant intensity was ineffective. Mitral stenosis patients were not investigated.. We performed a multicenter randomized trial in 1,209 patients at risk. The intermediate-risk group included patients with risk factors or age >60 years: 242 received the cyclooxygenase inhibitor triflusal, 237 received acenocumarol, and 235 received a combination of both. The high-risk group included patients with prior embolism or mitral stenosis: 259 received anticoagulants and 236 received the combined therapy. Median follow-up was 2.76 years. Primary outcome was a composite of vascular death and nonfatal stroke or systemic embolism.. Primary outcome was lower in the combined therapy than in the anticoagulant arm in both the intermediate- (hazard ratio [HR] 0.33 [95% confidence interval (CI)0.12 to 0.91]; p = 0.02) and the high-risk group (HR 0.51 [95% CI 0.27 to 0.96]; p = 0.03). Primary outcome plus severe bleeding was lower with combined therapy in the intermediate-risk group. Nonvalvular and mitral stenosis patients had similar embolic event rates during anticoagulant therapy.. The combined antiplatelet plus moderate-intensity anticoagulation therapy significantly decreased the vascular events compared with anticoagulation alone and proved to be safe in atrial fibrillation patients.

Topics: Acenocoumarol; Aged; Anticoagulants; Atrial Fibrillation; Cause of Death; Dose-Response Relationship, Drug; Drug Therapy, Combination; Embolism; Female; Follow-Up Studies; Hemorrhage; Humans; International Normalized Ratio; Intracranial Embolism; Male; Middle Aged; Mitral Valve Stenosis; Platelet Aggregation Inhibitors; Proportional Hazards Models; Salicylates; Survival Analysis; Treatment Outcome

The efficacy of the antiplatelet agent triflusal for prevention of vascular events after stroke has been reported in a pilot study. However, there is a need to confirm those results in a larger study.. We performed a randomized, double-blind, multicenter study to test the efficacy of triflusal (600 mg/d) versus aspirin (325 mg/d) for prevention of vascular events in patients with stroke or transient ischemic attack (Triflusal versus Aspirin in Cerebral Infarction Prevention [TACIP]). We assessed a combined end point (incidence of nonfatal ischemic stroke, nonfatal acute myocardial infarction, or vascular death) as well as the incidence of these events separately and the incidence of major hemorrhage.. Of 2113 patients, 1058 received triflusal and 1055 aspirin. The mean follow-up period was 30.1 months. The incidence of combined end point (13.1% for triflusal, 12.4% for aspirin) as well the survival analysis (hazard ratio [HR] for triflusal versus aspirin, 1.09; 95% CI, 0.85 to 1.38) showed no differences between groups. The incidence of nonfatal stroke (HR, 1.09; 95% CI, 0.82 to 1.44), nonfatal acute myocardial infarction (HR, 0.95; 95% CI, 0.46 to 1.98,) and vascular death (HR, 1.22; 95% CI, 0.75 to 1.96) was also similar. A significantly higher incidence of major hemorrhages in the aspirin group was recorded (HR, 0.48; 95% CI, 0.28 to 0.82). The overall incidence of hemorrhage was significantly lower in the triflusal group (16.7% versus 25.2%) (odds ratio, 0.76; 95% CI, 0.67 to 0.86; P<0.001).. This study failed to show significantly superior efficacy of triflusal over aspirin in the long-term prevention of vascular events after stroke, but triflusal was associated with a significantly lower rate of hemorrhagic complications.

Topics: Aspirin; Cardiovascular Diseases; Cerebral Infarction; Double-Blind Method; Female; Hemorrhage; Humans; Incidence; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Salicylates; Secondary Prevention; Stroke; Survival Analysis

Pulmonary embolism (PE) is a serious complication following hip surgery. Trials of antiplatelet thromboprophylaxis indicated a substantial reduction in PE rate, and we prospectively studied the effect of a combination of low-dose heparin and two different antiplatelets. Furthermore, our experience in previous studies suggested that platelet count (PC) levels could be useful to reliably suspect PE at a very early stage, and we prospectively tried to confirm our previous findings. Ours is a prospective study in 459 consecutive patients operated on because of hip fracture (265) or elective hip replacement (194), aimed to determine: 1) whether the benefits of antiplatelets plus heparin on PE outweigh the risks; 2) to assess the clinical usefulness of PC monitoring in these patients, so as to confirm whether PE could be recognized early. It was a prospective, randomized, double-blind study. All patients received unfractioned heparin (7500 IU sc twice daily, starting 2 h before operation). In addition, they received aspirin (200 mg thrice daily, with meals), Triflusal (300 mg thrice daily, with meals), or placebo. Real time B-mode ultrasonography (US) was performed on all patients on the 8-9th day after surgery. Venography was performed in patients with normal US, if clinical symptoms suggested venous thrombosis. Twelve out of the 459 patients (2.6%) had to discontinue prophylaxis, because of major bleeding (6 patients), or gastric intolerance (6 patients). There were no significant differences between groups in either deep vein thrombosis (26 patients (18%) with aspirin, 18 (12%) with Triflusal, 26 (17%) with placebo), or PE development (7 patients (5%) with aspirin, 3 (2%) with Triflusal, 8 (5%) taking placebo).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aged, 80 and over; Aspirin; Double-Blind Method; Drug Therapy, Combination; Female; Hemorrhage; Heparin; Hip Fractures; Hip Prosthesis; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Platelet Count; Postoperative Complications; Prospective Studies; Pulmonary Embolism; Radionuclide Imaging; Salicylates; Thrombophlebitis; Treatment Outcome; Ultrasonography; Vomiting

We have compared the effects of acetyl salicylic acid (ASA, aspirin) and choline magnesium trisalicylate (CMT), a non-acetylated salicylate product, on platelet aggregation in human whole blood ex-vivo. Using a whole blood platelet counter, platelet aggregation was quantified by measuring the fall in the number of single platelets at peak aggregation in response to collagen, arachidonic acid (AA), as well as spontaneous aggregation. In double blind and random order, 12 healthy volunteers received, on two separate occasions 10 days apart, a single oral dose of 652 mg ASA or 655 mg CMT. Despite a comparable absorption of salicylic acid from the two drugs, ingestion of ASA resulted in a marked inhibition of platelet aggregation induced by collagen (p less than 0.005), AA (p less than 0.01) and spontaneous aggregation (p less than 0.01), whereas such effects were not observed after CMT ingestion. We suggest that CMT may have therapeutic potential as an alternative to aspirin when inhibition of platelet aggregation can induce bleeding complications.

Topics: Adolescent; Adult; Aspirin; Choline; Clinical Trials as Topic; Hemorrhage; Humans; In Vitro Techniques; Male; Platelet Aggregation; Platelet Aggregation Inhibitors; Platelet Count; Salicylates

Warfarin is a widely used oral anticoagulant with established reversal guidelines in the setting of a supratherapeutic international normalized ratio (INR). Limited literature exists on managing acute warfarin overdoses in patients who are not chronically anticoagulated.. A 15-year-old male, with no indication for anticoagulation, presented to a pediatric emergency department after an acute 1,000 mg warfarin ingestion. He had no significant complaints upon presentation aside from a mild intermittent headache. His past medical history was significant for anxiety, depression, Tourette syndrome, attention deficit hyperactivity disorder, and polysubstance misuse. Computed tomography of his head was unremarkable and serum acetaminophen, salicylate, and ethanol concentrations were negative. Approximately 16 h post-ingestion, his INR was 1.9 with an increase to 3.3 by 26 h. The regional poison center was consulted and recommended, consistent with the CHEST guidelines, holding treatment with vitamin K until INR was >10 or if signs or symptoms of bleeding occurred. The patient was admitted for monitoring and by hospital day (HD) #4, his INR had risen to >11.8 at which point oral vitamin K 10 mg was administered. On HD #7, the patient was deemed stable for transfer to inpatient psychiatry after repeat INRs of 2.9 and 3.4.. Case reports have demonstrated early administration of vitamin K can temporarily lower INR and prevent detection of rebound. The CHEST warfarin reversal guidelines describe the risks and benefits with respect to bleeding and thrombosis in the non-intentional overdose patient. Application and extrapolation of these guidelines to acute overdose in patients who lack an indication for anticoagulation may or may not be warranted.. While established clinical guidance exists on reversing a supratherapeutic INR in patients chronically anticoagulated with warfarin, the risks and benefits of extrapolating this approach are unclear in those who lack an indication for anticoagulation.

Topics: Acetaminophen; Adolescent; Anticoagulants; Child; Ethanol; Hemorrhage; Humans; International Normalized Ratio; Male; Poisons; Salicylates; Vitamin K; Warfarin

Topics: Blood Coagulation Disorders; Hemorrhage; Humans; Salicylates

Topics: Blood Coagulation Disorders; Hemorrhage; Humans; Salicylates

Salsalate may offer many advantages over other non-steroidal antiinflammatory agents in patients taking warfarin, however a drug-drug interaction may occur which has not been reported in the medical literature or by the manufacturer of salsalate.. To report a case of warfarin potentiation associated with salsalate treatment, which resulted in bleeding.. Clinical review of the course of a patient, who was stable on warfarin when salsalate therapy was added for chronic pain.. A patient taking stable doses of warfarin for over 1 year (with good control) was prescribed salsalate 3 g/day for pain in his knee and lower back. Approximately 1 month later he presents to the anticoagulation clinic with bruising and an International Normalized Ratio (INR) of 6.8. The patient had a good response to his salsalate therapy and wanted to continue it. The warfarin was held for 3 days and dose lowered by 50 %. His bruising then subsided and he had good control of his warfarin therapy with INRs ranging from 1.9 to 2.2 over the next 4 months. The patient was then lost to follow up.. This case illustrates a strong association between starting salsalate and subsequent potentiation of warfarin, which heretofore has not been reported in the medical literature.

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Chronic Pain; Drug Interactions; Hemorrhage; Humans; International Normalized Ratio; Male; Salicylates; Warfarin

Warfarin-drug interactioions, which can result in life-threatening bleeding, are preventable. A 53-year-old man was admitted to hospital with exacerbation of chronic obstructive airways disease, cor pulmonale, pneumonia, deep vein thrombosis and acute pulmonary embolism. His pulmonary thromboemobolism was initially treated by low-molecular-weight-heparin and heparin. After a loading dose of 5 mg for 2 days, warfarin was given in a daily dose of 2 mg. On the fifth day of warfarin therapy, the last dose of Enoxaparin was given in the morning. He had a fall in the bathroom with blunt injury to the right flank. He complained of right thigh numbness and increasing pain and swelling over his right flank and abdomen. A tender mass was noted over the right flank. His Hb level dropped to 9.7 g/dl. His INR increased from 2.46 to 3.49-3.71 one day later. On further questioning, he admitted self applications of 20 g of Analgesic balm (50% methyl salicylate) over his right calf for 3 days. CT scan showed a large right retroperitoneal haematoma and right iliacus intramuscular haematoma. Warfarin was withheld. He was given fresh frozen plasma, packed cells and vitamin K(1). Inferior vena cava filter was inserted. The haematomas were resolving. He was subsequently discharged to convalescence hospital for continuation of anticoagulant therapy and close monitoring. Significant usage of topical methyl salicylate ointment can potentiate the anticoagulant effect of warfarin. The over-anticoagulation and the presence of platelet dysfunction increase the risk of severe bleeding, which can be provoked by trauma.

Topics: Anticoagulants; Drug Interactions; Hemorrhage; Humans; International Normalized Ratio; Male; Middle Aged; Partial Thromboplastin Time; Retroperitoneal Space; Salicylates; Warfarin

To study the main comedications associated with major bleeding during anticoagulant therapy with coumarins in a non-selected population under everyday circumstances.. The study population for this retrospective cohort study included all new users of phenprocoumon or acenocoumarol aged 40-80 years, during the period 1992-2000 in the PHARMO Record Linkage System. All patients were followed until the last dispensing of phenprocoumon or acenocoumarol, the first bleeding complication requiring hospitalization, death, or the end of the study period. The number of days on coumarins alone and the number of days on coumarins in combination with several potentially interactive drugs during follow-up were determined for each patient.. The inclusion criteria of this study were met by 19,935 new users of phenprocoumon or acenocoumarol. During follow-up, 552 patients were hospitalized for bleeding. Of all potentially interactive drugs started during anticoagulant therapy by at least 50 patients and with at least five bleedings, antibacterial drugs were associated with a four to seven times increased risk of bleeding. Among non-steroidal anti-inflammatory drugs, naproxen had the highest relative risk. Antithrombotic salicylates and tramadol were associated with a three times increased risk of bleeding.. Antibacterial drugs, non-steroidal anti-inflammatory drugs, antithrombotic salicylates and tramadol were the main potentially interactive drugs associated with major bleeding during anticoagulant therapy with coumarins under everyday circumstances.

Topics: Acenocoumarol; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Cohort Studies; Coumarins; Drug Interactions; Drug Monitoring; Female; Hemorrhage; Humans; Male; Middle Aged; Phenprocoumon; Retrospective Studies; Salicylates

Although during treatment of arthrosis with meloxicam the level of thromboxan A2 decreases, thrombocyte functions are not affected. Meloxicam in therapeutic doses doesn't increase the risk of haemorrhage. Previously it was suspected that co-administration of salicylates with certain other non-steroid antiinflammatory drugs (NSAIDs) will suppress the effect of salicylate. Van Ryn et al have proved that this is not the case with salicylate plus meloxicam therapy. It is hypothesized that meloxicam loosely binds to the cyclooxygenase-1 (COX-1) enzyme and salicylate can easily replace it.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Cyclooxygenase Inhibitors; Drug Therapy, Combination; Hemorrhage; Humans; Meloxicam; Osteoarthritis; Salicylates; Thiazines; Thiazoles

The basic phospholipase A(2) (VRV-PL-VIIIa) from Vipera russelli venom induces multiple toxic effects including neurotoxicity, myotoxicity, edema and hemorrhage. This phospholipase A(2) has been extensively characterized for its pharmacological properties except for hemorrhagic activity. In the present investigation, the lung hemorrhagic activity was assayed using lung dye diffusion method. The investigations to understand the mechanism of lung hemorrhage induction by VRV-PL-VIIIa was followed by chemical modification studies and also by interaction with an antihemorrhagic factor p-anisic acid (4-methoxy benzoic acid). In presence of 1:2 mol:mol PLA(2): anisic acid, the lung hemorrhagic and edema inducing activities were completely neutralized in experimental animals; however, catalytic and anticoagulant activities were not neutralized. Carbamylation of VRV-PL-VIIIa resulted in the loss of lung hemorrhage and edema inducing activities. In contrast, carbamylation of VRV-PL-VIIIa in the presence of anisic acid could not neutralize the lung hemorrhage and edema inducing activities. The anticoagulant and enzyme activities were only partially neutralized when carbamylated both in the presence and absence of anisic acid.

Topics: Animals; Anticoagulants; Betaine; Carbamyl Phosphate; Daboia; Edema; Group II Phospholipases A2; Hemolysis; Hemorrhage; Hydroxybenzoate Ethers; Lung Diseases; Male; Mice; Phospholipases A; Proteins; Prothrombin Time; Rats; Salicylates; Spectrometry, Fluorescence; Viper Venoms

To report a case of international normalized ratio (INR) elevation resulting from the administration of topical methyl salicylate in a patient whose INR was previously stable while she received warfarin anticoagulation.. A 22-year-old white woman presented with an INR of 12.2 after applying a topical pain-relieving gel to her knees daily for eight days. The potentiation of the warfarin anticoagulation was attributed to the low-dose methyl salicylate contained in the product.. Methyl salicylate is systemically absorbed through the skin in measurable amounts, and may increase warfarin action by affecting vitamin K metabolism or by displacing warfarin from protein-binding sites. While several investigators have reported this interaction with use of high-dose methyl salicylate, this case indicates that a significant interaction can occur with the use of lower topical doses of methyl salicylate as well.. Healthcare providers and patients taking warfarin must be aware of the potential hazard of using topical methyl salicylate in combination with warfarin.

Topics: Administration, Topical; Adult; Anticoagulants; Drug Synergism; Female; Fixatives; Hemorrhage; Humans; International Normalized Ratio; Ointments; Salicylates; Warfarin

This paper deals with two patients on warfarin in whom the use of topical methylsalicylate preparations led to clinically significant bleeding problems. The first patient required fresh frozen plasma to tide over the crisis while the second patient recovered spontaneously on stopping the warfarin temporarily. The possible mechanisms by which salicylates potentiate the anticoagulant effect of warfarin are briefly outlined.

Topics: Adult; Anti-Inflammatory Agents; Anticoagulants; Drug Interactions; Female; Gingiva; Hematoma; Hemorrhage; Humans; Leg; Male; Middle Aged; Salicylates; Steroids; Warfarin

The safety of the combination of heparin and ridogrel therapy and its antiplatelet efficacy was examined in the setting of percutaneous transluminal coronary angioplasty (PTCA). In 32 patients without known aspirin intake for 10 days before PTCA, therapy with ridogrel (300-mg intravenous bolus) was begun just before PTCA and continued orally at a dose of 300 mg twice daily until discharge. Heparin was administered as a 10,000 IU bolus dose before PTCA and followed by an intravenous infusion at a rate of 1,000 IU/hour for 24 hours. Bleeding problems at the arterial entry site occurred in 13 patients, which required a blood transfusion in only 2 patients. One patient underwent emergency bypass surgery without specific problems of hemostasis. Ridogrel virtually eliminated thromboxane B2 from the serum (29,990 +/- 6,555 pg/0.1 ml before vs 63 +/- 7 pg/0.1 ml at 2 hours after ridogrel), with a concomitant increase in serum 6-keto-prostaglandin F1 alpha (511 +/- 34 pg/0.1 ml before vs 1,190 +/- 146 pg/0.1 ml at 24 hours after ridogrel). There were no acute reocclusions in the ridogrel-treated patients, whereas acute reocclusions occurred in 5.6% of the patients taking the standard aspirin + heparin regimen during the same period. Furthermore, at 6-month clinical follow-up patients treated with ridogrel compared favorably with those receiving standard treatment.

Topics: 6-Ketoprostaglandin F1 alpha; Administration, Oral; Aged; Angioplasty, Balloon, Coronary; Coronary Disease; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Hemorrhage; Heparin; Humans; Male; Middle Aged; Pentanoic Acids; Pilot Projects; Pyridines; Radiography; Recurrence; Salicylates; Thromboxane B2; Thromboxane-A Synthase

Topics: Acenocoumarol; Drug Therapy, Combination; Hemorrhage; Humans; Male; Middle Aged; Nephrectomy; Polycystic Kidney Diseases; Salicylates

Topics: Animals; Dithiothreitol; Hemorrhage; Male; Mixed Function Oxygenases; Quinones; Rats; Rats, Inbred Strains; Salicylates; Salicylic Acid; Vitamin E; Vitamin K Epoxide Reductases

The anticoagulant property of aspirin has long been appreciated. Recently, the physiologic mechanism has been identified and documented extensively. Despite the long-lasting inhibition of platelet function and clinically significant postoperative hemorrhage following aspirin use, few serious complications or fatalities are reported in the current literature. We report a case in which fatal hemorrhage resulted from minor trauma following massive salicylate ingestion. A review of the cyclo-oxygenase mechanism is presented.

Topics: Alcoholism; Aspirin; Death, Sudden; Hemorrhage; Humans; Lung Diseases; Male; Mediastinal Diseases; Middle Aged; Purpura; Salicylates; Thrombocytopenia; Wounds, Nonpenetrating

Topics: Aspirin; Carbenicillin; Female; Hemorrhage; Humans; Nitrofurantoin; Penicillin G; Platelet Aggregation; Pregnancy; Salicylates

Not considering the complications due to anesthesia, postoperative hemorrhage is certainly the most frequent complication following tonsillectomy. When injury of a major vessel can be ruled out as the cause of bleeding, a discrete disturbance of hemostasis must be considered. These are mainly thrombocytopathies or a pathologically increased fibrinolysis which were not detected by routine tests and the past history. Preoperatively one should ask for more or less regular use of analgesics containing salicylates which should not be administered postoperatively. The worst attitude is case of a post-tonsillectomy hemorrhage is to do nothing or to rely on non-specific measures hoping that the bleeding will stop anyway.

Topics: Aged; Blood Coagulation Disorders; Child; Fibrinolysis; Hemorrhage; Humans; Male; Salicylates; Taste Disorders; Tonsillectomy

Topics: Blood Platelet Disorders; Female; Hemorrhage; Humans; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Pregnancy; Salicylates

Topics: Animals; Antibodies; Antigen-Antibody Complex; Arthus Reaction; Autacoids; Capillary Permeability; Chromatography, DEAE-Cellulose; Complement System Proteins; Guinea Pigs; Hemorrhage; Histamine; Immunoglobulin G; Indomethacin; Kinins; ortho-Aminobenzoates; Phenylbutazone; Prostaglandins; Salicylates; Snakes; Toluene; Venoms

Topics: Animals; Chlortetracycline; Dietary Carbohydrates; Female; Glucose; Heart Diseases; Hemorrhage; Male; Prothrombin Time; Rats; Salicylates; Sucrose; Swine; Swine Diseases; Syndrome; Vitamin K

Topics: Animals; Aspirin; Female; Fetal Death; Gestational Age; Hemorrhage; Liver Glycogen; Mice; Pregnancy; Salicylates

Topics: Analgesics; Anti-Inflammatory Agents; Bone Marrow Diseases; Chloroquine; Corticosterone; Gold; Hematologic Diseases; Hemorrhage; Humans; Indomethacin; Phenacetin; Phenylbutazone; Salicylates

Topics: Abnormalities, Drug-Induced; Animals; Chemical and Drug Induced Liver Injury; Female; Fetal Death; Fetal Diseases; Gastrointestinal Hemorrhage; Gestational Age; Hemorrhage; Injections, Intramuscular; Liver; Mice; Pentobarbital; Pregnancy; Salicylates

Topics: Aged; Feces; Female; Hemorrhage; Humans; Hypoprothrombinemias; Malabsorption Syndromes; Male; Nutrition Disorders; Salicylates

Topics: Acute Disease; Adolescent; Adult; Child; Child, Preschool; Female; Fever; Follow-Up Studies; Hemorrhage; Humans; Infant; Infant, Newborn; Leukocytosis; Male; Middle Aged; Otitis Media; Peritonsillar Abscess; Pneumonia; Postoperative Complications; Respiratory Tract Infections; Salicylates; Sex Factors; Sinusitis; Tonsillectomy; Tonsillitis

Topics: Animals; Female; Fetal Death; Fetal Diseases; Fetus; Gestational Age; Hemorrhage; Liver Diseases; Mice; Necrosis; Pregnancy; Salicylates; Sodium; Species Specificity

Topics: Aspirin; Drug Tolerance; Hemorrhage; Humans; Salicylates

Topics: Animals; Anti-Inflammatory Agents; Capillaries; Connective Tissue; Depression, Chemical; Granulation Tissue; Hemorrhage; Hydrocortisone; Leukocytosis; Phenylbutazone; Rats; Salicylates; Time Factors; Wound Healing

Topics: Absorption; Animals; Aspirin; Bethanechol Compounds; Denervation; Dogs; Gastric Mucosa; Gastrins; Gastrointestinal Hemorrhage; Hemorrhage; Histamine; Intestinal Absorption; Ion Exchange; Pharmacology; Research; Salicylates; Salicylic Acid; Sympathomimetics; Toxicology

Topics: Anthracosilicosis; Hemorrhage; Humans; Kidney Diseases; Lung Diseases; Muscular Diseases; Penicillins; Radiography, Thoracic; Salicylates; Scleroderma, Systemic; Vitamin E

Topics: Aspirin; Gastrointestinal Tract; Hemorrhage; Humans; Mouth; Mucous Membrane; Phenacetin; Salicylates; Stomach

Topics: Aspirin; Digestion; Gastrointestinal Hemorrhage; Hemorrhage; Salicylates; Toxicology

Topics: Cardiac Surgical Procedures; Gastrointestinal Hemorrhage; Hemorrhage; Mitral Valve Stenosis; Postoperative Complications; Salicylates; Thoracic Surgery; Toxicology

Topics: Aspirin; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates

Topics: Administration, Intravenous; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates

Topics: Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates

Topics: Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates

Topics: Gastrointestinal Hemorrhage; Hemorrhage; Humans; Hydrochloric Acid; Salicylates

Topics: Digestion; Gastric Juice; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates

Topics: Hemorrhage; Humans; Salicylates; Salicylic Acid

Topics: 2,4-Dinitrophenol; Barbiturates; Brain; Chlorpromazine; Cyanides; Dinitrophenols; Glutamine; Hemorrhage; In Vitro Techniques; Nitrophenols; Salicylanilides; Salicylates

Topics: Aspirin; Eye Diseases; Hemorrhage; Humans; Papilledema; Salicylates

Topics: Gastrointestinal Hemorrhage; Gastrointestinal Tract; Hemorrhage; Humans; Salicylates

Topics: Anemia; Anemia, Hypochromic; Gastrointestinal Hemorrhage; Gastrointestinal Tract; Hematologic Diseases; Hemorrhage; Humans; Salicylates

Topics: Aspirin; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates; Stomach; Stomach Diseases

Topics: Aspirin; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates; Stomach; Stomach Diseases

Topics: Adrenochrome; Hemorrhage; Hemostasis, Surgical; Humans; Salicylates

Topics: Aspirin; Capillaries; Capillary Fragility; Hemorrhage; Hemorrhagic Disorders; Humans; Salicylates; Vascular Diseases

Topics: Aspirin; Hemorrhage; Humans; Salicylates

Topics: Adrenochrome; Epistaxis; Hemorrhage; Humans; North Carolina; Nose; Pharynx; Salicylates

Topics: Gastrointestinal Hemorrhage; Gastrointestinal Tract; Hemorrhage; Humans; Salicylates

Topics: Gastrointestinal Hemorrhage; Gastrointestinal Tract; Hemorrhage; Humans; Salicylates; Stomach Diseases

Topics: Hematology; Hemorrhage; Hemorrhagic Disorders; Rheumatic Diseases; Rheumatic Fever; Salicylates

Topics: Aspirin; Hemorrhage; Humans; Liver; Salicylates

Topics: Adenoids; Hemorrhage; Palatine Tonsil; Salicylates; Tonsillectomy

Topics: Hemorrhage; Mental Disorders; Salicylates; Substance-Related Disorders; Tooth Extraction

Topics: Blood Coagulation; Hemorrhage; Hemostatics; Humans; Prothrombin; Salicylates

Topics: Aspirin; Blood; Chewing Gum; Hemorrhage; Hemostatics; Humans; Prothrombin; Salicylates; Tonsillectomy

Topics: Aspirin; Blood Coagulation; Hemorrhage; Hypoprothrombinemias; Salicylates

Topics: Hemorrhage; Plasma; Rheumatic Diseases; Salicylates

Topics: Aspirin; Hemorrhage; Humans; Salicylates